Increasing impact of COVID-19 on young adults: evidence from hospitalisations in Brazil.

OBJECTIVES: Concerns about the increasing impact of severe COVID-19 in younger individuals in Brazil came after a recent synchronised country-wide wave of cases in Brazil. This communication analyses how hospitalisations due to COVID-19 changed in the age groups 18-49 years and ≥70 years. STUDY DESIGN: Longitudinal study based on secondary data. METHODS: Data from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records (including COVID-19 notifications), were used in this study. Statistical control charts examined changes in the magnitude and variation of younger (18-49 years) and older (≥70 years) adults who were hospitalised between 15th March 2020 and 19th June 2021. RESULTS: During the few first weeks of the pandemic in Brazil, the number of COVID-19 hospitalisations increased in older adults but decreased in younger adults. Subsequently, hospitalisations reached statistical control zones in epidemiological weeks (EW) 19-48 of 2020 (EW 19-48/2020) and EW 03-05/2021 (18-49 y, mean = 26.1%; ≥70 y, mean = 32.8%). Between EW 49/2020 and EW 02/2021, the number of hospitalisations of younger adults dropped to levels below the lower control limit. In contrast, the number of hospitalisations of older adults surpassed the upper limit of the corresponding statistical control zones. However, from EW 06/2021, numbers of hospitalisations changed from statistical control zones, with hospitalisations of younger adults increasing and reaching 44.9% in EW 24/2021 and hospitalisations of older adults decreasing until EW 19/2021 (14.1%) and reaching 17.3% in EW 24/2021. CONCLUSIONS: An increasing number of COVID-19 hospitalisations were observed in younger adults from EW 06/2021. This could be a result of the successful vaccination programme in older adults, who were initially prioritised, and possibly an increased exposure to highly transmissible variants of COVID-19 in younger adults who had to go to work in the absence of social protection (i.e. government financial support). Potential consequences of COVID-19 hospitalisations in younger adults could include a reduced life expectancy of the population and an increased number of people unable to perform daily activities due to post-COVID-19 conditions.

ZnO-based nanofungicides: Synthesis, characterization and their effect on the coffee fungi Mycena citricolor and Colletotrichum sp.

In this work we compare the antifungal capacity of zinc oxide nanoparticles (ZnO-NPs) synthesized by a chemical route and a ZnO-based nanobiohybrid obtained by green synthesis in an extract of garlic (Allium sativum). To find out the characteristics of the materials synthesized, X-ray diffraction (XRD), IR spectroscopy and absorption in UV-Vis were used, as well as both scanning (SEM) and transmission (TEM) electron microscopy. The results showed that the samples obtained were of nanometric size (<100 nm), with a predominance of the wurtzite crystal phase of ZnO and little crystallization of the nanobiohybrids. Their antifungal capacity on two pathogenic fungi of coffee, Mycena citricolor (Berk and Curt) and Colletotrichum sp. was also evaluated. Both nanomaterials showed an efficient antifungal capacity, particularly the nanobiohybrids, with ~97% inhibition in growth of M. citricolor, and ~93% for Colletotrichum sp. The microstructural study with high resolution optical (HROM) and ultra-structural microscopy (using TEM) carried out on the fungi treated with the synthesized nanomaterials showed a strong nanofungicidal effect on the vegetative and reproductive structures and fungal cell wall, respectively. The inhibition of the growth of the fungi and micro and ultra-structural affectations were explained considering that the size of the nanomaterials allows them to pass easily through the cell membranes. This indicates that they can be absorbed easily by the fungi tested here, causing cellular dysfunction. Nanofungicide effects are also attributable to the unique properties of nanomaterials, such as the high surface-to-bulk ratio of atoms and their surface physicochemical characteristics that could directly or indirectly produce reactive oxygen species (ROS), which affect the proteins of the cell wall.

Blood clearance of Howell-Jolly bodies in an experimental autogenic splenic implant model.

BACKGROUND: Autogenic splenic implant (ASI) is one of the few alternatives for preservation of splenic tissue when total splenectomy is inevitable. The aim of this study was to determine the morphological and functional regeneration of ASIs, as indicated by the clearance of Howell-Jolly (HJ) bodies, in an experimental model. METHODS: Ninety-nine male Wistar rats were divided into three groups: sham-operated (group 1), total splenectomy alone (group 2), and total splenectomy combined with ASI (group 3). Animals in group 3 were further allocated to nine subgroups of nine rats each, and analysed at different time points (1, 4, 8, 12, 16, 20, 24, 28 and 32 weeks after surgery). Blood smears were prepared at predetermined times for detection of HJ bodies. Morphological regeneration of tissue in the ASI was analysed by histology. RESULTS: At 1 week, the regenerated mass corresponded to about 7 per cent of the tissue implanted, reaching approximately 54 per cent at 24 weeks. The HJ body levels were increased in groups 2 and 3 until 8 weeks after surgery, following which levels in the ASI group became similar to those in the sham-operated group. HJ bodies were difficult to detect when a level of 22.5 per cent of regenerated ASI mass was reached. CONCLUSION: Functional regeneration of ASIs occurred from 8 weeks after surgery. When 22.5 per cent of regenerated ASI mass was reached almost no HJ bodies could be observed in the bloodstream, resembling a spleen in situ. SURGICAL RELEVANCE: Splenectomy has been practised routinely, both in the emergency setting and as a therapeutic elective procedure. There is a correlation between asplenia/hyposplenia and the occurrence of fulminant sepsis, underlining the importance of developing surgical methods for preserving splenic function. Both clinical and experimental studies have shown at least partial morphological and functional regeneration of autogenic splenic implants (ASIs). Experimental studies investigating the immunoprotective effect of ASIs, based mostly on exposure of animals to various bacteria, have demonstrated that ASIs can increase the rate of bacterial clearance and decrease mortality from sepsis. Clinical studies have shown their ability to remove colloidal substances and altered erythrocyte corpuscular inclusions, such as Howell-Jolly, Heinz and Pappenheimer bodies, from the bloodstream. In this experimental study the functional and morphological regeneration of ASIs was studied over time in rats.

Critical mass of splenic autotransplant needed for the development of phagocytic activity in rats.

When total splenectomy is inevitable, heterotopic splenic autotransplantation seems to be the only alternative to maintain the functions of the spleen. The present study was carried out to analyse the critical mass of splenic autotransplant (SAT) for the development of phagocytic activity in rats. Wistar rats were submitted to total splenectomy (TS) alone or in combination with slices of SAT ranging from an average rate of 21·9% (one slice) to 100% (five slices) of the total splenic mass implanted into the greater omentum. Sixteen weeks after the beginning of the experiment, the animals were inoculated intravenously with a suspension of Escherichia coli labelled with Tc-99m. After 20 min, the rats were killed and the liver, lung and spleen or SAT, as well as blood samples were removed to determine the percentage of labelled bacteria uptake in these tissues. As the percentage of the total splenic mass contained in the SAT increased, the bacteria remaining in the blood decreased. From the implant of 26% up to the implant of the total splenic mass (100%) there was no difference in the bacteria remaining in the blood between the healthy animals of the control group and those submitted to TS combined with SAT. This finding shows that the critical mass needed for the development of phagocytic activity of macrophages in splenic autotransplants in adult rats is 26% of the total splenic mass.

Physiological and physico-chemical characterization of dietary fibre from the green seaweed Ulva fasciata Delile.

This work aims to assess the potential of the green seaweed Ulva fasciata Delile as an alternative source of dietary fibre (DF). Total DF content was determined, some of its physico-chemical properties described and the physiological effects of U. fasciata meal on rats fed a hypercholesterolemic diet were investigated. U. fasciata may be considered a potential alternative source of DF with a total content of about 400 g.kg-1 (dry basis) and interesting physico-chemical properties: water retention capacity of 8.74 g/water.g-1 dry sample (seaweed meal) and 0.90 (seaweed carbohydrate extract), lipid adsorption capacity of 4.52 g/oil.g-1 dry sample (seaweed meal) and 5.70 (seaweed carbohydrate extract), intrinsic viscosity of 2.4 dl.g-1 (seaweed carbohydrate extract) and cation exchange capacity of 3.51 Eq.kg-1 (seaweed carbohydrate extract). The diet containing seaweed meal was able to keep rats' total cholesterol (TC) down without causing any undesirable increase in LDL-C fraction. No evidence of toxic and/or antinutritional components in the seaweed meal was detected. Rats showed a fecal volume much greater (13 g) than that fed on cellulose diet (7 g) (p < 0.05). These properties confer on the seaweed the potential to be used in food technology for the acquisition of low-calorie food and might be important in body weight control, reduction of blood TC and LDL-C as well as in prevention of gastrointestinal diseases.

Physiological and physico-chemical characterization of dietary fibre from the green seaweed Ulva fasciata Delile / Caracterização fisiológica e físico-química da fibra alimentar da macroalga marinha verde Ulva fasciata Delile

This work aims to assess the potential of the green seaweed Ulva fasciata Delile as an alternative source of dietary fibre (DF). Total DF content was determined, some of its physico-chemical properties described and the physiological effects of U. fasciata meal on rats fed a hypercholesterolemic diet were investigated. U. fasciata may be considered a potential alternative source of DF with a total content of about 400 g.kg-1 (dry basis) and interesting physico-chemical properties: water retention capacity of 8.74 g/water.g-1 dry sample (seaweed meal) and 0.90 (seaweed carbohydrate extract), lipid adsorption capacity of 4.52 g/oil.g-1 dry sample (seaweed meal) and 5.70 (seaweed carbohydrate extract), intrinsic viscosity of 2.4 dl.g-1 (seaweed carbohydrate extract) and cation exchange capacity of 3.51 Eq.kg-1 (seaweed carbohydrate extract). The diet containing seaweed meal was able to keep rats' total cholesterol (TC) down without causing any undesirable increase in LDL-C fraction. No evidence of toxic and/or antinutritional components in the seaweed meal was detected. Rats showed a fecal volume much greater (13 g) than that fed on cellulose diet ( 7 g) (p < 0.05). These properties confer on the seaweed the potential to be used in food technology for the acquisition of low-calorie food and might be important in body weight control, reduction of blood TC and LDL-C as well as in prevention of gastrointestinal diseases.

Este trabalho objetivou avaliar o potencial da alga marinha verde Ulva fasciata Delile como fonte alternativa de fibra alimentar. Foram realizadas a determinação do teor de fibra alimentar total e a descrição de algumas propriedades físico-químicas, e os efeitos fisiológicos da farinha da alga seca sobre ratos alimentados com dieta hipercolesterolemizante foram investigados. Esta alga pode ser considerada uma fonte alternativa potencial de fibra com cerca de 400 g.kg-1 (base seca) e propriedades físico-químicas interessantes: uma capacidade de retenção de água de 8,74 g/água.g-1 de amostra seca (farinha de alga) e 0,90 (extrato de carboidratos), uma capacidade de adsorção de lipídeos de 4,52 g/óleo.g-1 de amostra seca (farinha de alga) e 5,70 (extrato de carboidratos), uma viscosidade intrínseca de 2,4 dl.g-1 (extrato de carboidrato da alga) e capacidade de troca iônica de 3,51 Eq.kg-1 (extrato de carboidrato). A dieta contendo farinha de alga foi capaz de manter baixos os níveis de colesterol total de ratos sem causar aumento indesejável na fração LDL-C. Nenhuma evidência de componentes tóxicos e/ou antinutricionais na farinha de alga foi encontrada. Os ratos mostraram um volume fecal maior (13 g) do que aqueles alimentados com dieta contendo celulose como fonte de fibra (7 g) (p < 0,05). Essas propriedades conferem a alga o potencial de ser utilizada na tecnologia de alimentos para a aquisição de alimentos de baixas calorias, podendo ser importante para o controle do peso corporal, redução do colesterol sanguíneo total e da fração LDL-C, como também na prevenção de doenças gastrintestinais.

Cost effectiveness and delivery study for future HIV vaccines.

Research teams from five countries, Brazil, China, Kenya, Peru and Thailand, have initiated a policy-maker survey on vaccine delivery, cost studies for future HIV vaccination programmes, and associated simulation modeling exercises analysing the relative cost-effectiveness of potential HIV vaccination strategies. The survey assesses challenges and opportunities for future country-level HIV vaccination strategies, providing data on the vaccine characteristics (e.g. vaccine efficacies for susceptibility, infectiousness and disease progression) and vaccination programme strategies to be considered in the cost-effectiveness modeling analyses. The study will provide decision-makers with modeling data on vaccination policy considerations that will assist in developing country-level capacities for future HIV vaccine policy adoption and effective delivery systems, and will help delineate the long-term financial requirements for sustainable HIV vaccination programmes. The WHO-UNAIDS HIV Vaccine Initiative and the collaborating researchers welcome comments or questions from policy makers, health professionals and other stakeholders in the public and private sectors about this effort to help advance policy and capacity related to future potential HIV vaccines.

Regeneration of splenic autotransplants.

Splenic autotransplantation seems to be the only alternative for preservation of splenic tissue after total splenectomy. This work was carried out to analyze the morphologic regeneration of autotransplanted splenic tissue in Wistar rats and to determine the bacterial phagocytic function of their macrophages. We utilized an experimental model including young and adult rats, of both sexes, submitted to total splenectomy combined with autotransplantation in the greater omentum of slices of the whole mass of spleen. Sixteen weeks later animals were intravenously inoculated with a suspension of Escherichia coli AB1157. There was regeneration of autotransplanted splenic tissue in all animals. A similar morphological aspect among all animals was observed, with splenic tissue showing red and white pulps with a moderate architectural disarrangement. Macrophages containing bacterial aggregates were observed, as well as macrophages with hemosiderin pigments inside the cytoplasm. Blood vessels showed preserved walls, with no signs of vasculitis or thrombosis. The present results suggest that splenic autotransplants in the greater omentum of the rat acquire the macro- and microscopic architecture of a normal spleen, with reduced dimensions, and preserve bacterial phagocyte function.

Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro.

CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.

[Cost variation of hospitalization due to injuries: head trauma and fire arm accidents]. / Variação no custo de internações hospitalares por lesões: os casos dos traumatismos cranianos e acidentes por armas de fogo.

This article proposes two linear regression models on cost variation of hospitalization (based on data from the Brazilian National Unified Health System - SUS) for two types of injuries: head trauma and related cases (n = 98,156); fire arm injuries and related cases (n = 8,970). Data were collected from the 1997 standardized Hospital Admittance Forms covering all of Brazil. Explanatory variables were gender, age, hospital administration model (public, private, etc.), region of the country, hospitalization in a capital city, use of ICU, surgery, death, duration of hospitalization, most frequent procedures, special procedures, and interaction among certain variables. The two models adjusted well, with R2 = 0.7264 for the first and 0.7663 for the second. Explanatory variables in the first model were all significant, and only three variables in the second failed to show statistical significance. The two main variables in both models were use of ICU and surgery. Diagnostics for detection of outliers, multicolinearity, model specification error, and homoscedasticity were performed.

[Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil]. / Tuberculose em populações indígenas de Rondônia, Amazônia, Brasil.

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records in the Rondonia State Tuberculosis Control Program, identifying the disease's profile among indigenous groups, which are socially more vulnerable and have different issues involved in controlling the disease. The study includes a descriptive statistical and multivariate multinomial analysis of cases reported in 1992 and from 1994 to 1998, attempting to identify factors associated with tuberculosis-related deaths, treatment drop-out, and missing data. Associations were identified between variables related to the disease, to the health service, and to treatment results. There is evidence that the indigenous populations in Rondonia have an increased risk of acquiring and dying from tuberculosis as compared to other residents of the State. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

[Body mass index and its relationship to nutritional and socioeconomic variables: a linear regression approach to a Brazilian adult sub-population]. / Indice de Massa Corporal e sua relação com variáveis nutricionais e sócio-econômicas: um exemplo de uso de regressão linear para um grupo de adultos brasileiros.

This paper focuses on the relationship between body mass index (BMI) and family energy intake, occupational energy expenditure, per capita family expenditure, sex, age, and left arm circumference for a group of Brazilian adults randomly selected among those interviewed for a survey on food consumption and family budgets, called the National Family Expenditure Survey. The authors discuss linear regression methodological issues related to treatment of outliers and influential cases, multicollinearity, model specification, heteroscedasticity, as well as the use of two-level variables derived from samples with complex design. The results indicate that the model is not affected by outliers and that there are no significant specification errors. They also show a significant linear relationship between BMI and the variables listed above. Although the hypothesis tests indicate significant heteroscedasticity, its corrections did not significantly change the model's parameters, probably due to the sample size (14,000 adults), making hypothesis tests more rigorous than desired.

[Variables associated with underreporting of AIDS patients in Rio de Janeiro, Brazil, 1996]. / Fatores associados à subnotificação de pacientes com Aids, no Rio de Janeiro, RJ, 1996.

OBJECTIVE: The underreporting of AIDS cases in the municipality of Rio de Janeiro, Brazil, is significant. The study intends to analyze the factors associated to this event. METHODS: Using data provided by the Hospital Information System for the year of 1996, in Rio de Janeiro city, and by the National Surveillance System, patients were randomly selected and their medical records reviewed to verify an AIDS diagnosis. A multinomial model was used to perform an analysis of the variations on the chances of underreporting of AIDS cases versus reporting and on the chances of underreporting without evidences to fulfill the case definition of AIDS versus reporting. RESULTS: No significant associations were found between the variables such as "age", "marital status", "level of education", "occupation", and "severity of illness" and the underreporting of AIDS cases. The variable "female gender" showed a strong association with hospitalization without evidence of an AIDS diagnosis. A strong association was found between two or more admissions in an inpatient unit care and reporting. The existence of a epidemiological surveillance department in the hospital is inversely associated with the underreporting of AIDS cases. CONCLUSION: The significant association between organizational variables and underreporting of AIDS cases found in the study point out to the need of standardization of the surveillance procedures, the especial need for the creation and maintenance of surveillance departments in hospitals to improve the quality of the health information system and, therefore, AIDS prevention and care.

Malignancy risk prediction for primary jejunum-ileal tumors.

This work is aimed at identifying factors associated with primary jejunum-ileal tumors malignancy, defining a prediction model with sensitivity, specificity and accuracy to distinguish malign from benign neoplasms. These tumors are rare, have highly unspecific presentation and, frequently, are diagnosed late. We reviewed the charts of 42 patients with primary jejunum-ileal tumors treated in the Department of General Surgery of Rio de Janeiro State University Hospital, Rio de Janeiro, RJ, Brazil, from 1969 to 1998. We performed bivariate analyses, based on chi 2 test, searching associations between tumors malignancy and demographic and clinical variables. Then logistic regression was employed to consider the independent effect of variables previously identified on malignancy risk. The malign tumors included 11 adenocarcinomas, 7 leiomyosarcomas, 5 carcinoids and 4 lymphomas; the benign tumors included 10 leiomyomas, 2 hamartomas, and single cases of adenoma, multiple neurilemoma and choristoma. The bivariate analyses indicated the association between malignancy and palpable abdominal mass (P = 0.003), period from signs and symptoms onset to diagnosis (P = 0.016), anemia (P = 0.020), anorexia (P = 0.003), abdominal pain (P = 0.031), weight loss (P = 0.001), nausea and vomit (P = 0.094), and intestinal obstruction (P = 0.066); no association with patients demographic characteristics were found. In the final logistic regression model, weight loss, anemia and intestinal obstruction were statistically associated with the dependent variable of interest. Based only on three variables--weight loss, anemia and intestinal obstruction--the model defined was able to predict primary jejunum-ileal tumors malignancy with sensitivity of 85.2%, specificity of 80.0%, and accuracy of 83.3%.

[Evaluation of under-reporting of AIDS cases in the city of Rio de Janeiro based on data from the hospital information system of the Unified Health System]. / Avaliação da subnotificação de casos de Aids no Município do Rio de Janeiro com base em dados do sistema de informações hospitalares do Sistema Unico de Saúde.

Data from the Hospital Information System (SIH-SUS) were linked to data from the AIDS Case Reporting System (Sinan) to assess the level of under-reporting of AIDS cases in the city of Rio de Janeiro. A high level of unreported cases(42.7%) was observed for patients treated in hospitals under Brazil's Unified Health System in the city of Rio. Bivariate analysis showed an association between reporting to the Sinan and age, principal diagnosis, and type of hospital.

Markers, cofactors and staging systems in the study of HIV disease progression: a review

This paper is aimed at providing a comprehensive review of markers, cofactors and staging systems used for HIV disease, focusing on some aspects that nowadays could even be considered historical, and advancing in current issues such as the prognostic value of viral load measurements, viral genotypic and phenotypic characterization, and new HIV disease treatment protocols. CD4 cell values, combined with the new viral markers mentioned are promising as a parsimonious predictor set for defining both severity and progression. An adequate predictor of patient resource use for planning purposes still needs to be defined.

Markers, cofactors and staging systems in the study of HIV disease progression: a review.

This paper is aimed at providing a comprehensive review of markers, cofactors and staging systems used for HIV disease, focusing on some aspects that nowadays could even be considered historical, and advancing in current issues such as the prognostic value of viral load measurements, viral genotypic and phenotypic characterization, and new HIV disease treatment protocols. CD4+ cell values, combined with the new viral markers mentioned are promising as a parsimonious predictor set for defining both severity and progression. An adequate predictor of patient resource use for planning purposes still needs to be defined.

Estimating the effectiveness of perinatal care technologies by expert opinion.

The majority of technologies in use in perinatal care were organized into 45 technological functions. Forty-six experts from 19 different regions of Brazil and other Latin American countries then selected a "basic package" (BP) of 15 technological functions. Considering the 12 main causes of perinatal mortality in Brazil, the experts estimated the number of preventable deaths, assuming universal coverage by the BP and the additional reductions that could be obtained by gradually adding other technological functions to the BP. A simulation was performed for the 26 states of Brazil to identify regional priorities for the diffusion of technological functions. For most regions, the BP appears to be the most effective intervention, with the potential of reducing perinatal mortality by 33%, followed by "coordination of services and referral of pregnant women" (14%), and "treatment of respiratory conditions" (11.8%).